Organization
KIDS CHOICE DENTAL PUYALLUP, LLC
Active
Other names
Kids Choice Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAHADEED S VIRK DMD (OWNER OPERATOR)
(253) 848-7000
Entity
Organization
Contact information
Practice address
9317 113TH ST E, SUITE A, PUYALLUP, WA 98373-3876
(253) 848-7000
(253) 604-0598
Mailing address
9317 113TH ST E, SUITE A, PUYALLUP, WA 98373-3876
(253) 848-7000
(253) 604-0598
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
603591386
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2010685
—
WA
Enumeration date
03/29/2016
Last updated
04/01/2016
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